Most Read Articles
Rachel Soon, 16 Aug 2019

On 8 August, the first town hall held by the Ministry of Health (MOH) with members of the pharmacy profession took place in Putrajaya. Over 500 pharmacists from across the country and from different areas of practice—community and hospital, public and private, academy and industry—converged to fill the auditorium for the chance to engage in direct dialogue with MOH.

Jackey Suen, 08 Oct 2018

Adding pertuzumab to trastuzumab plus an aromatase inhibitor (AI) improves progression-free survival (PFS) in patients with HER2-positive metastatic or locally advanced breast cancer, the phase II PERTAIN study has shown.

05 Aug 2019
Use of alpha blockers in the treatment of hypertension in women is associated with an increased risk of hypotension and related events as compared with other blood pressure-lowering drugs, as reported in a recent study.
Dr. Bryan Li, Dr. Gerry Kwok, Dr. Thomas Yau, 07 Aug 2019

Case 1: A 59-year-old gentleman with advanced HCC was referred to our centre for management. He had a history of diabetes, hypertension and ischaemic heart disease. He was a nondrinker and not a carrier of hepatitis B or C.

Case 2: A 65-year-old man with a history of alcoholic cirrhosis and oesophageal varices was found to have rising AFP levels on routine follow-up. He also had a 3-year history of diabetes and was on diet control, with an HbA1c of 6.2 percent and fasting glucose of 6.8 mmol/L. He did not need any diabetic medications.

Baricitinib improves clinical, functional, radiographic outcomes in RA

Audrey Abella
02 Jul 2019

Early use of the oral Janus kinase 1/2 inhibitor baricitinib led to enhanced clinical, functional, and radiographic efficacy compared with methotrexate monotherapy in patients with rheumatoid arthritis (RA), according to data presented at EULAR 2019.

To assess the potential of early baricitinib therapy in achieving improved clinical and functional outcomes, researchers evaluated data from the RA-BEGIN* cohort (n=588, mean disease duration 1.4 years) wherein participants were randomized 4:3:4 to receive methotrexate once weekly, baricitinib 4 mg once daily (early-start group), or both for 52 weeks. A long-term extension phase ensued thereafter, whereby all participants were given baricitinib 4 mg. The methotrexate recipients who switched to baricitinib comprised the delayed-start group. [EULAR 2019, abstract THU0075]

Four weeks into the switch to baricitinib, the percentage of patients in the delayed-start arm who achieved low disease activity (SDAI** ≤11) and remission (SDAI ≤3.3) increased from 60 to 78 percent and 18 to 31 percent, respectively. At week 100, >80 percent of the population in both arms had low disease activity and nearly half achieved remission.

HAQ-DI*** scores were lower in the early- vs the delayed-start arm from baseline to week 52, diverging as early as week 1 (p≤0.001) up until week 52 (p≤0.01). The drop in HAQ-DI score in the delayed-start arm 4 weeks following the transition to baricitinib signified functional improvement, which was sustained up to week 100.

These findings underscore the potential of baricitinib in improving clinical and functional outcomes in methotrexate-naïve RA patients, noted the researchers. The transition from methotrexate to baricitinib led to favourable clinical improvements as early as 4 weeks post-switching. “However, if the goal of therapy is to achieve rapid and sustained control of disease activity, the differences [in] HAQ-DI [scores] … support earlier switch to baricitinib for patients who do not obtain disease control with methotrexate,” the researchers pointed out.

 

Haemoglobin in structural damage progression

In a post hoc analysis, researchers investigated the effect of baricitinib on structural damage progression based on baseline haemoglobin levels using data from RA-BEAM# (n=487, 328, and 488 for baricitinib 4 mg, adalimumab, and placebo, respectively) and RA-BEGIN. [EULAR 2019, abstract SAT0102]

Pooled results of both studies showed that participants with higher baseline haemoglobin levels were less likely to show structural damage progression at 52 weeks (adjusted odds ratio [adjOR], 0.76; p<0.001 [RA-BEAM] and adjOR, 0.72; p=0.001 [RA-BEGIN]), independent of other factors included in the multivariate regression model. This finding supports evidence reflecting an inverse association between haemoglobin levels and radiographic progression of structural joint damage in RA. [Arthritis Care Res (Hoboken) 2018;70:861-868; Ann Rheum Dis 2014;73:691-696]

In RA-BEAM, among patients with low or normal baseline haemoglobin levels, structural damage progression was less frequent in baricitinib or adalimumab vs placebo recipients (11.2 percent or 10.5 percent vs 32.6 percent [low haemoglobin level] and 7.6 percent or 6.5 percent vs 15.5 percent [normal haemoglobin level]).

In RA-BEGIN, patients with low baseline haemoglobin levels who received baricitinib alone/with methotrexate had lower rates of structural damage progression vs those on methotrexate monotherapy (18.3 percent/10.0 percent vs 35.6 percent). In patients with normal baseline haemoglobin, the difference between treatments was less pronounced (12.8 percent/10.1 percent vs 13.4 percent).

Taken together, the findings from both trials showed that baricitinib reduced structural damage progression, which was more pronounced in methotrexate-treated patients with low baseline haemoglobin levels, noted the researchers.

Further investigation is warranted to explore prognostic factors such as high-sensitivity C-reactive protein, disease duration, baseline erosion, and anti-citrullinated protein antibody positivity to aid clinicians in identifying suitable candidates for early baricitinib treatment, said the researchers.

 

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Most Read Articles
Rachel Soon, 16 Aug 2019

On 8 August, the first town hall held by the Ministry of Health (MOH) with members of the pharmacy profession took place in Putrajaya. Over 500 pharmacists from across the country and from different areas of practice—community and hospital, public and private, academy and industry—converged to fill the auditorium for the chance to engage in direct dialogue with MOH.

Jackey Suen, 08 Oct 2018

Adding pertuzumab to trastuzumab plus an aromatase inhibitor (AI) improves progression-free survival (PFS) in patients with HER2-positive metastatic or locally advanced breast cancer, the phase II PERTAIN study has shown.

05 Aug 2019
Use of alpha blockers in the treatment of hypertension in women is associated with an increased risk of hypotension and related events as compared with other blood pressure-lowering drugs, as reported in a recent study.
Dr. Bryan Li, Dr. Gerry Kwok, Dr. Thomas Yau, 07 Aug 2019

Case 1: A 59-year-old gentleman with advanced HCC was referred to our centre for management. He had a history of diabetes, hypertension and ischaemic heart disease. He was a nondrinker and not a carrier of hepatitis B or C.

Case 2: A 65-year-old man with a history of alcoholic cirrhosis and oesophageal varices was found to have rising AFP levels on routine follow-up. He also had a 3-year history of diabetes and was on diet control, with an HbA1c of 6.2 percent and fasting glucose of 6.8 mmol/L. He did not need any diabetic medications.